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While the number of Medicaid enrollees who may be disenrolled during the unwinding period is highly uncertain, it is estimated that millions will lose coverage. The lower estimate accounts for factors, such as new people enrolling in the program as well as people disenrolling then re-enrolling in the program within the year, while the higher estimate reflects total disenrollment and does not account for churn or new enrollees. These projected coverage losses are consistent with, though a bit lower than, estimates from the Department of Health and Human Services HHS suggesting that as many as 15 million people will be disenrolled, including 6.
While the share of individuals disenrolled across states will vary due to differences in how states prioritize renewals, it is expected that the groups that experienced the most growth due to the continuous enrollment provision—ACA expansion adults, other adults, and children—will experience the largest enrollment declines. Efforts to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage.
Enrollees may experience short-term changes in income or circumstances that make them temporarily ineligible. Alternatively, some people who remain eligible may face barriers to maintaining coverage due to renewal processes and periodic eligibility checks.
Eligible individuals are at risk for losing coverage if they do not receive or understand notices or forms requesting additional information to verify eligibility or do not respond to requests within required timeframes. Churn can result in access barriers as well as additional administrative costs. Estimates indicate that among full-benefit beneficiaries enrolled at any point in , About 4. Another analysis examining a cohort of children newly enrolled in Medicaid in July found that churn rates more than doubled following annual renewal, signaling that many eligible children lose coverage at renewal.
By halting disenrollment during the PHE, the continuous enrollment provision has also halted this churning among Medicaid enrollees. CMS requires states to develop operational plans for how they will approach the unwinding process. These plans must describe how the state will prioritize renewals, how long the state plans to take to complete the renewals as well as the processes and strategies the state is considering or has adopted to reduce inappropriate coverage loss during the unwinding period.
An Information Bulletin CIB posted on January 5 included timelines for states to submit a renewal redistribution plan. According to a KFF survey conducted in January , states were taking a variety of steps to prepare for the end of the continuous enrollment provision Figure 4. Twenty-eight states indicated they had settled on plan for prioritizing renewals while 41 said they planning to take 12 months to complete all renewals the remaining 10 states said they planned to take less than 12 months to complete renewals or they had not yet decided on a timeframe.
A majority of states also indicated they were taking steps to update enrollee contact information and were planning to follow up with enrollees before terminating coverage. But the situation is evolving—as of December 2, , 35 states had posted their full plan or a summary of their plan publicly. How states approach the unwinding process will have implications for the ability of eligible individuals to retain coverage and those who are no longer eligible to transition to other coverage.
Outcomes will differ across states as they make different choices and face challenges balancing workforce capacity, fiscal pressures, and the volume of work. Some states suspended renewals as they implemented the continuous enrollment provision and made other COVID-related adjustments to operations. Completing renewals by checking electronic data sources to verify ongoing eligibility reduces the burden on enrollees to maintain coverage.
However, in many states, the share of renewals completed on an ex parte basis is low. As states return to routine operations when the continuous enrollment provision ends, there are opportunities to promote continuity of coverage among enrollees who remain eligible by increasing the share of renewals completed using ex parte processes and taking other steps to streamline renewal processes which will also tend to increase enrollment and spending.
CMS notes in recent guidance that states can increase the share of ex parte renewals they complete without having to follow up with the enrollee by expanding the data sources they use to verify ongoing eligibility. However, when states do need to follow up with enrollees to obtain additional information to confirm ongoing eligibility, they can facilitate receipt of that information by allowing enrollees to submit information by mail, in person, over the phone, and online.
While nearly all states accept information by mail and in person, slightly fewer provide options for individuals to submit information over the phone 39 states or through online accounts 41 states. A proposed rule , released on September 7, , seeks to streamline enrollment and renewal processes in the future by applying the same rules for MAGI and non-MAGI populations, including limiting renewals to once per year, prohibiting in-person interviews and requiring the use of prepopulated renewal forms.
As states prepare to complete redeterminations for all Medicaid enrollees once the continuous enrollment provision ends, many may face significant operational challenges related to staffing shortages and outdated systems. To reduce the administrative burden on states, CMS announced the availability of temporary waivers through Section e 14 A of the Social Security Act. These waivers will be available on a time-limited basis and will enable states to facilitate the renewal process for certain enrollees with the goal minimizing procedural terminations.
When the continuous enrollment provision ends and states resume redeterminations and disenrollments, certain individuals will be at increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers completing the renewal process, even if they remain eligible for coverage. Enrollees who have moved may not receive important renewal and other notices, especially if they have not updated their contact information with the state Medicaid agency.
In , one in ten Medicaid enrollees moved in-state and while shares of Medicaid enrollees moving within a state has trended downward in recent years, those trends could have changed in and A recent analysis of churn rates among children found that while churn rates increased among children of all racial and ethnic groups, the increase was largest for Hispanic children, suggesting they face greater barriers to maintaining coverage.
Additionally, people with LEP and people with disabilities are more likely to encounter challenges due to language and other barriers accessing information in needed formats. A recent analysis of state Medicaid websites found that while a majority of states translate their online application landing page or PDF application into other languages, most only provide Spanish translations Figure 7.
That same analysis revealed that a majority of states provide general information about reasonable modifications and teletypewriter TTY numbers on or within one click of their homepage or online application landing page Figure 8 , but fewer states provide information on how to access applications in large print or Braille or how to access American Sign Language interpreters.
CMS guidance about the unwinding of the continuous enrollment provision stresses the importance of conducting outreach to enrollees to update contact information and provides strategies for partnering with other organizations to increase the likelihood that enrollee addresses and phone numbers are up to date. CMS guidance also outlines specific steps states can take, including ensuring accessibility of forms and notices for people with LEP and people with disabilities and reviewing communications strategies to ensure accessibility of information.
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WebThe Centers for Medicare & Medicaid Services (CMS) reimbursement policy identified 11 preventable adverse outcomes. Of these 11 patient outcomes, four (severe pressure . WebJan 11, · 1. Medicaid enrollment has increased since the start of the pandemic, primarily due to the continuous enrollment provision. Total Medicaid/CHIP enrollment . WebJan 5, · Federal Policy Guidance. The Centers for Medicare & Medicaid Services (CMS) is responsible for implementing laws passed by Congress related to .